Pancho - MON-YAN-75

Code: MON-YAN-75
Mercy ID: V-01285-01
Encounter Date: 07/15/2003
Last: Monje
First: Jaenette
DOB: 11/19/1975
County: Gwinnett
Street: 252 Bethesda Church Rd.
City: Lawrenceville
State: GA

Zip

30044-

Cell

(678) 684-5351

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

High school graduate

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	N/A	N/A	N/A
Father	N/A	N/A	N/A
Step Parent	N/A	N/A	N/A

Driver: YES
Relative: No
Stranger: No
Lives With: N/A
Name of School: N/A
Grade: N/A
Who Can't Pickup the Child
Authoritation Parent: No
Authoritation Child: No
DOY PERMISO: No
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: J. Perez
Data Entry: K. Aleman